Luepker R V, Raczynski J M, Osganian S, Goldberg R J, Finnegan J R, Hedges J R, Goff D C, Eisenberg M S, Zapka J G, Feldman H A, Labarthe D R, McGovern P G, Cornell C E, Proschan M A, Simons-Morton D G
Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454-1015, USA.
JAMA. 2000 Jul 5;284(1):60-7. doi: 10.1001/jama.284.1.60.
Delayed access to medical care in patients with acute myocardial infarction (AMI) is common and increases myocardial damage and mortality.
To evaluate a community intervention to reduce patient delay from symptom onset to hospital presentation and increase emergency medical service (EMS) use.
The Rapid Early Action for Coronary Treatment Trial, a randomized trial conducted from 1995 to 1997 in 20 US cities (10 matched pairs; population range, 55,777-238,912) in 10 states.
A total of 59,944 adults aged 30 years or older presenting to hospital emergency departments (EDs) with chest pain, of whom 20,364 met the primary population criteria of suspected acute coronary heart disease on admission and were discharged with a coronary heart disease-related diagnosis.
One city in each pair was randomly assigned to an 18-month intervention that targeted mass media, community organizations, and professional, public, and patient education to increase appropriate patient actions for AMI symptoms (primary population, n=10,563). The other city in each pair was randomly assigned to reference status (primary population, n=9801).
Time from symptom onset to ED arrival and EMS use, compared between intervention and reference city pairs.
General population surveys provided evidence of increased public awareness and knowledge of program messages. Patient delay from symptom onset to hospital arrival at baseline (median, 140 minutes) was identical in the intervention and reference communities. Delay time decreased in intervention communities by -4.7% per year (95% confidence interval [CI], -8.6% to -0.6%), but the change did not differ significantly from that observed in reference communities (-6. 8% per year; 95% CI, -14.5% to 1.6%; P=.54). EMS use by the primary study population increased significantly in intervention communities compared with reference communities, with a net effect of 20% (95% CI, 7%-34%; P<.005). Total numbers of ED presentations for chest pain and patients with chest pain discharged from the ED, as well as EMS use among patients with chest pain released from the ED, did not change significantly.
In this study, despite an 18-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI. JAMA. 2000;284:60-67
急性心肌梗死（AMI）患者延迟获得医疗救治的情况很常见，这会增加心肌损伤和死亡率。
评估一项社区干预措施，以减少患者从症状出现到就医的延迟，并增加紧急医疗服务（EMS）的使用。
冠状动脉治疗快速早期行动试验，这是一项于1995年至1997年在美国10个州的20个城市（10对匹配城市；人口范围为55,777 - 238,912）进行的随机试验。
共有59,944名30岁及以上因胸痛到医院急诊科就诊的成年人，其中20,364人符合入院时疑似急性冠心病的主要人群标准，并在出院时被诊断为与冠心病相关。
每对城市中的一个被随机分配接受为期18个月的干预措施，该措施针对大众媒体、社区组织以及专业、公众和患者教育，以增加患者对AMI症状采取适当行动（主要人群，n = 10,563）。每对城市中的另一个被随机分配为对照状态（主要人群，n = 9801）。
比较干预组和对照组城市对之间从症状出现到到达急诊科的时间以及EMS的使用情况。
总体人群调查表明公众对项目信息的知晓度和了解有所提高。干预组和对照组社区中，患者从症状出现到入院的基线延迟时间（中位数为140分钟）相同。干预组社区的延迟时间每年减少-4.7%（95%置信区间[CI]，-8.6%至-0.6%），但与对照组社区观察到的变化无显著差异（每年-6.8%；95%CI，-14.5%至1.6%；P = 0.54）。与对照组社区相比，干预组社区中主要研究人群对EMS的使用显著增加，净效应为20%（95%CI，7% - 34%；P < 0.005）。胸痛患者到急诊科就诊的总数、从急诊科出院的胸痛患者以及从急诊科出院的胸痛患者中EMS的使用情况均无显著变化。
在本研究中，尽管进行了为期18个月的干预，但胸痛患者从症状出现到入院的时间在两组之间没有差异变化，尽管干预组社区中适当使用EMS的情况有所增加。如果要进一步减少疑似AMI患者从症状出现到就医的延迟时间，需要新的策略。《美国医学会杂志》。2000年；284:60 - 67
